HomeMy WebLinkAbout22753-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-24005
Date NOVEMBER 2, 1995
THIS CERTIFIES that the buildin~
Location of Property 560 DEER DRIVE
House NO.
County Tax Map No. 1000 Section 114
Subdivision
ACCESSORY
MATTITUCK~ NEW YORK
Street Hamlet
Block 10 Lot 4
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 18, 1995 pursuant to which
Building Permit No. 22753-Z dated MAY 11, 1995
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ACCESSORY ABOVE GROUND SWIMMING POOL WITH F~NCE ENCLOSURE AS
APPLIED FOR.
The certificate is issued to
KEITH & LAURA BRINKI~a~NN
(owners)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N-364898- SEPT. 28, 1995
N/A
Rev. 1/81
~ ~/1 in/g~i~nspect or
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HAU.
$OUTHOLD, N.Y.
N~
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
22753 Z
CounlyTax Map No. 1000 Seotlon......~...,~- ,~... ....... Blook ........ .~..~... ........ LotNo ......... ¢¢~.....,~,.- ......
pursuant to application dated. ..'~../,?... ................................... 19..~....-~..~ and approved bythe
Building Inspector,
Fee *..~.,.~.
Rev, 6/30/80
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
Ai~PLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for t~he building.
6. Submit Planning Board Approval of completed site plan requirements.
For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing" land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00
3. Copy of Certificate of Occupancy - $20.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00., Commercial $15.00
Date .... .~/./¥~./.~..~ .........................
New Construction ........... Old Or Pre-existing Building .................
Location of Property..~.~..O-...'..........]2~.~....fl,RJ~'%/.~ ..... .... ~.~W...%~'~ ..... ....
House No. Street Hamlet
Onwer or Owners of Property.. ~ ....... ~,7.~.. .~.~.~U.~. .....................
County Tax Map No 1000, Section...~.~.~ ...... Block .... [~ ......... Lot ..... ~.~. ............
.
Subdivision..P.e.e .r... a.r .k .~5..~.~.~'~cK,.ed Map..~g~ ~...~o~ ..... I.~ .............
' 29 . ' .... '
Health Dept. Approval .......................... Underwriters Approval .........................
Planning Board Approval ........................
Request for: Temporary Certificate ........... Final Certicate...~.~...
Fee Submitted: $.. ~ ......................
..... ~%~q005 APPLICANT
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1195197 BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK. NEW YORK 10038
D. te SEPT~I4BER 28,1995 /lpplication No. on file 88799295/95 N 364898
THIS CERTIFIES THAT
only t~ electrical equipment as d~scribed below and ii, traduced by the applicant named on the above application number in the premises of
KIF~TH BRINI~ANN, 560 DEER PARK~ MATTITUCK, N.Y~
in the followlng location; [] Basement [] Ist FI. ~ 2nd FL OUT ,Section Block Lot
t~s examlned on SEPTEMBER 22,1995 attd found to be in corttpliattce with the National Electrical Code.
OTHER
SWI~9~ING POOL-q.
SPECIAL RECRPT,AHP, 20-1
G.F.C,I-1
*(SWIP~ffNG POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
~nvironments it is advisable to
have frequept test/and or repairs
made by a qualified person,
<<< Continued on Page 2 >>>
RANGES
F'ECIAL BBC'PT
R
COOKING DECKS OVENS DISH WASHERS
TIMECLOCKSJ BELL IUI~ITHEATERSUNIT HEATERS MULTI.OUTLET
V I C
EXHAUST FANS
DIMMERS
AWG.
OF CC. COND,
NO OF HI-LEG
A,W.G- NO.OF NEUTRALS A,W, G.
OF HI-LEG OF NEUTRAL
GENERAL MANAGER
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by }heir credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIRCATE Must NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1195197 BUREAU OF ELECTRICITY
-- 85 JOHN STREET, NEW YORK. NEW YORK 10038
SEPTEMBER 28,1995 88799295/95' N 364898 /lpplication No. o. file
TH ISYJ~,~ERTIFIES THAT
only Re electrical equipment as described belo*~ and introduced by the applicant named on the above application nuraber in the premises of
KIETH~ BRINKHANN, 560 DEER PARK~ MATTITUCK,
in the fotlowing h,catio,; [] Basement [] 1st FI. [] 2nd Fl. OUT Section Block Lot
SEPTB-'HBER 22,1995 and found to be in compliance with the Natz'onal Electrical Code.
DRYERS FURNACE MOTORS I FUTUKE APPLIANCE FEEDERS
AMT, K.W. OIL H,P, GAS H,P At4T, NO, A, w, G,
OTHER APPARATUS:
RANGES
K W,
~PECIAL REC'PT
R
TIME CLOCKS KELL UNIT HEATERS MULTI-OUTlET
SYSTEMS
A~T, AMPS. TRANS. NO. OF FEET
V I C E
A.W.G- NO OF HI-LEG
OF CC CQND.
SABA? EI~CTRIC
50 PAT LANE,
HATTITUCK, ~, 11952
V
I,IC.#4204-E
EXHAUST FANS
AMT, H P
DIMMERS
A,W,G !NO. OF NEUTRALS A,W, G.
OF HI-tEG OF NEUTRAL
mi
GENERAL MANAGER
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERT F CATE MUST NOT BE ALTERED IN ANY MANNER.
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their'-~redenfials.
FIELD I.~SPECTION REPORT DATE COMMENTS
FOUNDATION (2ND) II !! .................................
INSULATION PER N. Y.
STATE ENERGY
CODE
Town Hall, 53095 Main Road
P. O. Box t '179
Southold, New Yo~ 11971
Fax (516) 765-1823
Telephone (516) 765-1802
OFFICE OF THE BUILDING INSPECTOR
TOWN OF SOUTHOLD
June 12, 1995
Mr. Keith Brinkman
560 Deer Drive
Mattituck, NY 11952
To Whom This May Concern:
We are unable to complete your Certificate of Occupancy
because of the following reasons:
xx An application for Certificg.%e of Occupancy is
not on file. (Enclosed) ~-
xx No Underwriters Certificate on file.
xx The check is not on file. $25.00 ~
No Health Department Approval on file.
No final inspection has been made.
No Plumber Solder Certificate on file.
(All permits involving plumbing being
issued after April 1, 1984).
BUILDING PERMIT # 22753-Z
Please contact our office on this matter.
cooperation.
Thank you for
SOUTHOLD TOWN BUILDING DEPT.
765-180Z
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] FRAMING
[ ].~ULATION
[ ~ FINAL
[ ] FIREPLACE&CHIMNEY
REMARKS: //~/~-~//--/',~7
DATE
INSPECTOR
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION2ND [ ]INSULATION
[ ] FRAMING ['~INAL
[ ] FIREPLACE & CHIMNEY
LOT
LOT ~G 3 ,~-
MA, P OF
, RIJDOL?,H · M. ~' JoAN
AT
TOWN OF SOUTHOLD
· APR'I 9 ~ ; BUILDING DEPARTMENT
~ TOWN HALL
Examined.
Disapproved a/c .....................................
' d~n sp~
APPLICATION FOR BUILDING'PERMIT
BOARD OF HEALTH .........
3 SETS OF PLANS ..........
SURVEY ..................
.........
CALL ......
HAIL TO:
. ¢r;o.¢ ....
INSTRUCTIONS
Date ................ 19
' a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
'sets of plans, accurate plot plan to scale. Fee according to schedule.
~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public sti'ee~s
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation. ·
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant to the
Building Zone Ordinance of the Town of South01d, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit author/zed inspectors on premises and in building for necessary inspections.
-- (Signature of applicant, or name, if a corporation)
(Mailing address ot~ applicant)
State wt~ether applicant is owner, lessee, 'agent, architect, engineer, generM 'contractor, electrician, plumber or builder.
(/.¢. r)
Nmne of owner of premises. ~¢i .~..~. : . 8. ~. .I.r)./(tTt,~.63. . ?/....~..,.,.~.e~ .... ~. ~. .,.Q I~. . .FQ. .~ .~. ~ .......... (as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer.
(Name ami ~itle of corporate ~fficer) -
Builder's License No ......
Plumber s Lmense No ............... . ..........
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done..A~ c..~...q~, ql. ~-. ~ ...... ' ...... :...
House Number Street Hamlet
Couhty Tax Map No. 1000 Section . :.: I.l.'.$ ......... mock .... t.O ....... :... Lot...'.~. ~ ..........
(Name)
2: Stat~ existing use and occupancy of premises and intended use and occupancy of proposed constructiom
a. Existing use and occupancy ........ FCe~?'~a~.C.e... '
· 3. Nature of work (check which a~plicable): New Building .......... Addition..~ ........ Alteration ./, .........
Repmr .............. Removal .............. Demolition .... : ......... ~t Other Work... M'. ..
4. Estimated Costi...~...~".;~..o.~"" ... ' . ,' ' .
(to be paid on filing this application)
5. d 1 n u~be~of dwelhng ...... . Number of dwelling units on each floor ... .
. g g moerolcars ~ ~, (q . · .......
6. If business, commercial or mixdd occupancy, speeff,, nature an~ ~*~ U~ ~',Z. .......
...... ............ .... ; ...... Vk7~''" ''
' ' ~ u ~,~ u~,~a~, type Oi use . . .~ (7 ............
7. Dimensions of existing structures, if any: Front ....... l ....... Rear ............ Depth ............
Height : ............... Su~berofStories.. ~/~ .... '''
~h : : :r' ~'". ............. ~"'Z~"~"~:~ .......
D~ensions of shme structure ~1+~.+~ ....... Re
P~ , ~a~a~[~aua~ U~ aflqltlOnS: trent .........................
De '" ' .......... 4 HeiSt .... ,.
....................... ,.. Number of Stories ............ ~ .......
8. Dimensions of entire new construction: Front .............. : Rear ............... Depth .............
Height ............... Number of Stories ..........................
9. Sizeoflot Front ..~O q ' Re /~ 0~ ~ ........ 2~]'~ .... ' ......
.... , ......... ar .. ~ ......... Depth
10. Date of Purchase ......... ~ .............
............ ' ......... Name of Fomer Owner .................
11 Zone or use district in which pr~mises are situated ' ' ': ......
.12. D°es pr°p°sed construction vio ate any zoning law, ordina~ce or regulation: .~. ~.
13. WHllotberegraded ~.e~. I ........ '"'~ ' ...............
' 'l ' ' I ' ' 't ..... ~., ,~... WJlJ excess IlS De removea xrom premises: Yes
14. N~e of Owner of premises~g{MA/g~<~ ?A'5 fqXff~s 5~ ~ &. ~.Z~.;
s g~ ....... Phone No.~-~
Nme of Architect ............................ Address ................... Phone No ...............
15.' I.s this property within ~00 feet of a ~kh . · Y~--~.... No ....
~If yes,' Southold Town Trustees Permit may be required.
Locate clearly ~d distinctly ~1 buildMgs, Whether existing or proposed, ~d, indicate ~I set-back d~ensions from
property Nnes. Give street and block ~tumber or description accordMg to deed, and show street nines and indicate whether
Mtefior or comer lot. 1
FOLLOWING {NSPECTIONS:
3, FoUNDATiON " ~O REQUIRED'
-' ~NcRETE
FOR POURE~ ~
3/~N~$ULATION
4. FINAL" cOnSTRUCTION MUST
~F COMPLETE FOR
ALL CONSTRUCTION SHALL MEG'I
TNE ~EQUIREMENTS OF THE N.Y.
~[AIE CONSTRUCTION & E~EEGY
.5DES, NO% RESPONSIBLE FOR
0ESIGN OR CONSTRUCTION ERRORS
STATE OF NEW ~, ,
cou~ oF... ~s ~¢:L&, ,s.,s
... ~ ~.. ~.. ~,. ~. ~.< ~.. ........
being duly sworn, depose¢ ~d says that he is the applicant
(Name of individual si~nin~ contract)
above named.
Be is the ' 4 ~.~ '
' ~ (Contractor, agent, cor'porate officer, etc.) '
of said owner or owners, ~d fs duly authored to perfom or have perfomed the said work and to m~e and file this
application; that all statements contained b this'application are t'rue to the best of his ~owledge and belief; and that the
work w~l be perfomed in the ~r set forth in the application filed therewith. '
................. ......
· [yo=c .... <'/ ....... ~...~~ .... County . '
' ' ........
.... , . '... .